Pediatric Hospital Delivers Hope

by Chris Kraul

December 7, 2012 | Armed with an ACUSON Cypress cardiovascular system, doctors from the Fundación Cardioinfantil clinic in Bogota take their diagnostic and clinical expertise into the most remote, impoverished areas of Colombia to offer help to families who would otherwise have no access to advanced medical care for their ailing children.

The prognosis was grim for 11-year-old Nubia Quirino, the sickly daughter of an impoverished indigenous couple in Leticia, a steamy Amazon River port town in remote southeastern Colombia. She was born with a host of complex heart problems, including just one atrioventricular valve instead of two. The death sentence she was living under was visible in her cyanosis, or blue-grayish complexion, her swollen toes and fingers, and her gasps for breath after the slightest exertion.Local doctors had told Nubia’s parents, Herminio and Zoila, that there was nothing they could do for the child and that she would be lucky to live to her quinceanera, the traditional 15th birthday celebration that is every Colombian girl’s rite of passage. “She has gotten weaker and weaker, so we were resigned to losing her,” says Herminio Quirino, a member of the Ticuna native community on the outskirts of Leticia, which is accessible only by boat or airplane.

Diagnosis Offers Possible ReprieveBut the dark-eyed wisp of a girl with an impish smile may have gotten a reprieve when she was examined in March by a visiting team of doctors from Colombia’s leading pediatric hospital, Fundación Cardioinfantil of Bogota.The medical “brigade,” led by cardiologist Miguel Ronderos, MD, held a two-day clinic at Leticia’s San Rafael Hospital where, free of charge, they examined 305 children suspected by their parents of having heart problems. The doctors’ goal was to examine all comers, and, if necessary, take those who needed treatment back to Bogota.Ronderos examined Nubia with the Siemens ACUSON Cypress™ cardiovascular system, a compact and lightweight diagnostic unit that he has taken on dozens of similar pro bono “flying clinics” across the length and breadth of Colombia. Durable, weighing just 18 pounds, and taking up only as much space as a bulked-up attaché case, the unit renders highly defined images of exceptional quality.

Portability Makes the DifferenceRonderos had arrived in Leticia several days in advance and with his ultrasound system and other instruments in tow, had set out on a motorized canoe to visit several other villages along the Amazon to examine patients. Without a unit as rugged and compact as the ACUSON Cypress system, the trip would have been much less productive – perhaps even impossible.After scanning Nubia with the system, Ronderos got sharp images that revealed the girl’s serious cardiopathy. He immediately scheduled her visit to Bogota and probable surgery at Fundación Cardioinfantil later that month. Her medical, travel, and housing costs would be paid by the hospital’s charitable foundation, which budgets US$1.5 million a year to help poor children like Nubia.“I just hope we’re in time, because she is in a lot of danger and could suffer a heart attack at any moment,” says Ronderos, who trained at the University of Alabama-Birmingham School of Medicine in the USA. “There is no guarantee she will make it, but there is a good chance.”Dedicated doctors like Ronderos, supported by Siemens’ advanced diagnostic tools had once again brought hope to a family where previously none existed. The girl’s upcoming trip to Bogota for surgery came as a “total surprise, a gift from God,” her father says. “We thought there were no options.”By coming to Fundación Cardioinfantil for treatment, Nubia will receive another benefit that could be just as consequential to her long-term health. Any followup diagnosis, and possibly surgery, will be performed using Siemens’ state-of-theart low dose angiography systems. The hospital has four Artis® C-arm systems that can dramatically cut the radiationexposure of patients like Nubia, compared with what she would have received a few years ago. Decreased exposure is important because extended radiation used in angiography is known to increase the incidence of cancer, as well as other side effects.How is reduced radiation exposure accomplished? Siemens’ proprietary CARE (Combined Applications to Reduce Exposure) software, which is bundled into the Artis imaging systems, provides a broad range of dose-saving applications, including pulsed imaging, enhanced monitoring, and real-time reporting of the radiation being generated. The flexibility of use allows doctors to tailor treatment to a patient’s specific age, weight, and diagnosis. Over the last five years, Siemens software has also made 3D imaging possible, enabling physicians to better see the structure of vessels and organs. As one doctor puts it: “If you see better, you spend less time diagnosing the condition and placing coils, stents, and heart valves. That decreases the patient’s and medical staff’s exposure to radiation.” Low-dose treatment is important for Nubia, because, as Ronderos points out, if the first surgery is a success, she will need several more.

Angiography’s Expanding ApplicationsImproved safety is doubly critical because of the expanding range of diagnoses and treatments for which angiography is now being used, going far beyond its original cardiovascular application to include neurological and peripheral organ diagnoses and surgeries.The upshot is that Siemens’ advances in imaging technology now enable doctors to reduce the number of times a typical heart patient has to undergo angiography. A decade ago, patients like Nubia might have had to undergo three different procedures during their stay at Fundación Cardioinfantil: one to diagnose, a second to treat the disease, and a third to confirm success. But the likelihood now is that a single procedure will suffice.As one of a dozen Siemens “reference sites” at leading hospitals in Latin America and the Caribbean, Fundación Cardioinfantil has become a key proving ground for Siemens’ low-dose angiography initiative in the region and an incubator for more intensive relationships between Siemens product managers and the medical professionals who use the company’s equipment.“Over the last year, a real two-way flow of information with Siemens has begun, so that we can receive not just the technology, but also training and advice, and we want that to continue,” says Dario Echeverri, MD, the cardiologist who heads of Cardiac Catheterization Department. ”By the same token, we offer suggestions on design improvements,” he adds. Those have included, for example, smaller tables to accommodate pediatric patients and design changes for protective clothing.

Helping the Unfortunate

Giving underprivileged children life-saving options has been part of Fundación Cardioinfantil’s mission ever since its founding by two brothers, Reinaldo and Camilo Cabrera, who returned to Bogota in the early 1970s after their cardiology training at Houston’s Texas Medical Center, U.S.

The brothers devised a financing plan in which fees paid by wealthier heart patients, plus donations, would underwrite treatment for less fortunate ones. In the beginning, their clinic offered treatment only to youths from Bogota, or to those who could travel there.But since 1986, mobile medical “brigades” have gone to out-of-the-way or impoverished Colombian cities, where they conduct examinations at cooperating hospitals. The March visit to Leticia’s San Rafael Hospital by Ronderos and pediatricians Carolina Casas, MD, Linibeth Cruz, MD, and Sara Aguilera, MD, is one of ten such trips planned this year.Last year, the team examined 3,165 children during the trips, and 270 of them were taken to Bogota for further treatment, free of charge. Of those, 189 underwent heart surgery. “Without it, most would have died soon or over the next few years,” says Fabio Hencker, Fundación Cardioinfantil’s long-time community relations director.To get the word out before the clinics, the team depends on support from the community, churches, and radio stations. Prior to the team’s Leticia visit, the Colombian army hand-delivered posters advertising the clinic to each of the city’s 33 barrio captains and to dozens of indigenous community curacas, or mayors. Two soldiers, Eber Loyola and Esteban Cardozo, dressed up as clowns named Chechenko and Alambritto to entertain the kids as they waited outdoors for their exams.

“Leticia is so isolated, we don’t often have the opportunity to get this kind of service,” says an indigenous mother who brought her 1-year-old son, Jesue, in for an exam because his heart had been “palpitating” lately. Minutes later, Ronderos examined Jesue with the ACUSON Cypress system and found he had no serious heart problem.“Sometimes solving the problem just means giving the families peace of mind and reassuring them that everything is alright,” says Ronderos.